RESUMEN
BACKGROUND: Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined. METHODS: This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach. DISCUSSION: This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research. TRIAL REGISTRATION: This study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021, NCT05177393 .
Asunto(s)
Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas de Esófago/terapia , Cuidados Paliativos/métodos , Adulto , África Oriental , Investigación sobre la Eficacia Comparativa , Femenino , Recursos en Salud/provisión & distribución , Humanos , Estudios Longitudinales , Masculino , Estudios Observacionales como Asunto , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Nasogastric tubes (NGT) are widely used and generally harmless as such, complications are uncommon. NGT knotting is one such complication. We report a 45-month-old female with spontaneously knotted NGT that was identified and safely removed without complications. NGT knotting detection needs a high index of suspicion; if not detected and managed in a proper way, it may lead to severe complications. We discuss this case to raise awareness of this complication and how to minimize the likelihood of it happening and improve patient outcome.